Gülfe Anders, Wallman Johan K, Kristensen Lars Erik
Department of Clinical Sciences Lund, Rheumatology Section, Lund University, 221 84, Lund, Sweden.
Department of Rheumatology, Skåne University Hospital, 221 85, Lund, Sweden.
Arthritis Res Ther. 2016 Feb 19;18:51. doi: 10.1186/s13075-016-0950-0.
The development of EuroQol-5 dimensions (EQ-5D) utility over time in rheumatoid arthritis (RA) patients, treated with biologics other than tumour necrosis factor inhibitors (TNFi), based on the standard British (UK) and the new Swedish (SE) EQ-5D preference sets, has not been previously described.
Demographics, core set data, EQ-5D utility, and treatment characteristics for patients with established RA, receiving biologics in southern Sweden from January 2006 to March 2014, were retrieved from observational databases. Theoretical, UK, and experience-based, SE, EQ-5D mean utilities were plotted over time.
Data regarding 2418 treatment courses with abatacept (ABA, n = 100), rituximab (RTX, n = 230), tocilizumab (TOC, n = 121), or TNFi (n = 1967) were included in the analysis. Patients starting TNFi treatment, as expected, had shorter disease duration and less previous biologics. Baseline utilities of patients commencing ABA and TOC, but not RTX, were also lower than in the TNFi group. Following treatment initiation, rapid utility improvements were seen with all therapies, reaching plateaus after approximately 1.5 months, and then remaining fairly stable throughout follow-up in patients adhering to therapy. SE utilities were consistently higher than UK, with baseline values at around 0.7 leaving little room for improvement.
ABA, RTX, TOC, and TNFi treatments were all associated with favourable EQ-5D utility developments in RA patients adhering to therapy. The compression of the experience-based SE preference set towards higher utilities may compromise its ability to detect between-group differences in quality-adjusted life-years, thus making cost-effectiveness harder to demonstrate in cost-utility analyses applying this preference set, rather than the standard UK.
基于标准英国（UK）和新的瑞典（SE）EQ - 5D偏好集，肿瘤坏死因子抑制剂（TNFi）以外的生物制剂治疗的类风湿关节炎（RA）患者随时间推移的欧洲五维健康量表（EQ - 5D）效用发展情况，此前尚未见报道。
从观察性数据库中检索2006年1月至2014年3月在瑞典南部接受生物制剂治疗的确诊RA患者的人口统计学、核心数据集数据、EQ - 5D效用及治疗特征。绘制理论上的、英国的以及基于经验的瑞典EQ - 5D平均效用随时间的变化图。
分析纳入了2418个使用阿巴西普（ABA，n = 100）、利妥昔单抗（RTX，n = 230）、托珠单抗（TOC，n = 121）或TNFi（n = 1967）的治疗疗程的数据。正如预期的那样，开始TNFi治疗的患者病程较短且之前使用生物制剂的情况较少。开始使用ABA和TOC但不包括RTX的患者的基线效用也低于TNFi组。治疗开始后所有疗法的效用均迅速改善，在约1.5个月后达到平稳状态，然后在坚持治疗的患者整个随访期内保持相当稳定。SE效用始终高于UK，基线值约为0.7，几乎没有改善空间。
ABA、RTX、TOC和TNFi治疗对于坚持治疗的RA患者均与良好的EQ - 5D效用发展相关。基于经验的SE偏好集向更高效用的压缩可能会损害其检测组间质量调整生命年差异的能力，从而使得在应用此偏好集而非标准UK的成本效用分析中更难证明成本效益。
